Making a Data Dashboard on Your Metabolic Risk for Diabetes – for FREENovember 27, 2012
Making a Data Dashboard on Your Metabolic Risk for Diabetes – for FREEReference: Watkins et al, Stockholm Diabetes Meeting 2010 When you drive your car, you have a variety of tools in front of you. You have a speedometer, a gas gauge, a radio dial, a thermostat, a seat belt monitor etc. All so you can operate a car safely and comfortably. You have data at your finger tips. In medicine, we have curiously given over that power and information to our doctors without letting you in on the secret. Bit by bit, that’s changing, and needs to change. There is increasing data that lifestyle changes are more effective than pills at changing your risk for diabetes. The relative effectiveness is on the order of 3 to 1 lifestyle over pills. The real barrier is motivation. You see your doctor and are told, “Exercise and lose some weight, see you next year.” With that admonition, you might not do much. Next year, you get a pill because you didn’t get better. But that pill won’t prevent long term complications. Making lifestyle choices will. Hence, the problem is motivation for change. Enter the Tethys company with their PreDx test. The Tethys company has combined 7 markers for diabetes risk into an aggregate scoring mechanism from a single fasting specimen of blood. Their argument is that with seven risk factors for diabetes placed in front of you, you will develop your own intrinsic motivation to change behavior. You need data, just like when you drive your car. You need a variety of data from multiple angles that give you're an aggregate risk analysis. And, to be effective, you need to be able to get the data as often as you need to manage your life. Most importantly, it needs to be free, so you get it often enough to change behavior. The seven markers are glucose, HgbA1c, C-reactive protein, insulin, IL-2b, ferritin and Adiponectin. All together, these tests can cost close to $ 2,000 if done separately. But the Tethys company has persuaded enough insurance companies in America to cover it, including Medicare (not Medicaid) that they can now offer it to physicians to provide their patients access to it whenever they want. Now, very few are going to come in and overuse it. It costs society about $ 8000 a year to care for a diabetic. To help someone turn back their risk factors from bad, to moderate, to better, to optimal. This raises another critical point. Diabetes is not a Yes or No diagnosis. Granted, we say you are diabetic when your blood sugar is over 140, twice. We are nervous when your sugar is over 120. We advise you to exercise and lose weight if your sugar is over 100. But we know that you are still at risk for every point above 86. So, your blood glucose is a continuum of risk, and the lower the better. Optimum is less than 86. That same logic applies to all of the 7 markers. Glucose happens to be a late marker. Adiponectin changes first. CRP may also be way earlier. If we want to keep ourselves optimally well, isn’t is useful to know all the data that pertains to us? And wouldn’t it be nice to have that data repeated in three months after we have had a chance to really try hard and lose those 10 extra pounds? WWW. What will Work for Me? I really like this idea and have started running the PreDx test in my practice. Folks in large integrated health systems may not be able to get the PreDx test from the Tethys company because their labs may not be set up to do some of those tests. But the idea of getting your glucose, your insulin, your CRP and your HgbA1c as a baseline, and then repeatedly if you aren’t close to optimal is a pretty good one. My own score wasn’t optimum. I’m a bit rattled. I have a slightly elevated risk for becoming outright diabetic in the next 5 years. Grrr. Back to running and eating fewer carbs.